Nakai Yousuke, Oyama Hiroki, Kanai Sachiko, Noguchi Kensaku, Sato Tatsuya, Hakuta Ryunosuke, Ishigaki Kazunaga, Saito Kei, Saito Tomotaka, Hamada Tsuyoshi, Takahara Naminatsu, Mizuno Suguru, Kogure Hirofumi, Isayama Hiroyuki, Koike Kazuhiko
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan.
Dig Dis Sci. 2021 May;66(5):1540-1547. doi: 10.1007/s10620-020-06345-9. Epub 2020 May 20.
Endoscopic ultrasonography (EUS)-guided interventions are often performed using a single guidewire (SGW), but there are a few reports on the use of double guidewire (DGW) technique to facilitate multiple drainage placement during EUS-guided drainage of pancreatic fluid collections. This DGW technique may have advantages other than multiple drainage placement during EUS-guided interventions such as scope stabilization, support for stone extraction and device insertion.
Consecutive patients who underwent EUS-guided interventions between Feb 2012 and Apr 2019 were retrospectively reviewed. The rate and reasons of DGW technique, and clinical outcomes were evaluated. DGW technique was performed, using an uneven double lumen cannula (UDLC), which facilitates insertion of 0.025-in. and 0.035-in. guidewires.
A total of 249 EUS-guided interventions were analyzed, and DGW technique was utilized primarily in 65 cases (25.7%) and as a salvage after failed SGW technique in 18 cases (7.1%). The reasons for DGW technique were 60 multiple drainage placement, 10 scope stabilization, 7 device insertion, 5 safety guidewire, and 4 antegrade stone removal. Insertion of UDLC and DGW was successful in 100%. Technical success rate of preplanned interventions was 92.7% (96.9% in primary DGW and 77.8% in salvage DGW technique). Adverse events were observed in 19.5% after DGW but were not related to DGW technique.
DGW technique using UDLC during EUS-guided interventions was technically feasible and safe. In addition to multiple drainage insertion, it can potentially support complex EUS-guided interventions.
内镜超声（EUS）引导下的介入操作通常使用单导丝（SGW），但关于在EUS引导下胰腺液体积聚引流时使用双导丝（DGW）技术以促进多根引流管放置的报道较少。这种DGW技术在EUS引导下的介入操作中可能具有除多根引流管放置之外的其他优势，如内镜稳定、支持结石取出和器械插入。
回顾性分析2012年2月至2019年4月期间接受EUS引导下介入操作的连续患者。评估DGW技术的使用频率和原因以及临床结果。使用不均匀双腔插管（UDLC）进行DGW技术，该插管便于插入0.025英寸和0.035英寸的导丝。
共分析了249例EUS引导下的介入操作，其中65例（25.7%）主要使用了DGW技术，18例（7.1%）在SGW技术失败后作为补救措施使用了DGW技术。使用DGW技术的原因包括60例多根引流管放置、10例内镜稳定、7例器械插入、5例安全导丝和4例顺行结石取出。UDLC和DGW的插入成功率为100%。预先计划的介入操作的技术成功率为92.7%（初次DGW技术为96.9%，补救DGW技术为77.8%）。DGW技术后观察到19.5%的不良事件，但与DGW技术无关。
在EUS引导下的介入操作中使用UDLC的DGW技术在技术上是可行且安全的。除了多根引流管插入外，它还可能支持复杂的EUS引导下的介入操作。
